TEXAS MEDICAID FRAUD
Criminal Medicaid Fraud in Texas
Medicaid is a federal/state of Texas cost sharing program that provides health-care to people who are unable to pay for such care. In Texas, the Medicaid program is administered by the Texas Health and Human Services Commission.
More than 3.7 million Texans are eligible for Medicaid, and there are more than 57,000 active Medicaid providers. A provider can be any person, group of people, or health care facility that supplies medical services to Medicaid recipients. Providers include doctors, medical equipment companies, podiatrists, dentists, licensed professional counselors, hospitals, adult day care centers, nursing homes, clinics, pharmacies, ambulance companies, case management centers and others.
What is Texas Medicaid Fraud
These are examples of fraudulent use of the Medicaid plan:
- Providers billing TX Medicaid for X-rays, blood tests and other procedures that were never performed or falsifying a person’s diagnosis to justify unnecessary tests
- Providing a patient with a generic drug and billing Medicaid for the name-brand version of the medication
- Providing a recipient with a motorized scooter and billing for an electric wheelchair, which can cost three times more
- By billing Medicaid for care not given, for care given to patients who have died or who are no longer eligible, or for care given to patients who have transferred to another facility
- Transporting Medicaid patients by ambulance when it is not medically necessary
- Requiring vendors to kick back part of the money they receive for rendering services to Medicaid patients
- Billing Medicaid patients for services already paid for by the Medicaid plan
Fraudulent Activities of this nature violate federal and the state of Texas criminal laws and can result in significant fines and/or prison time. Those providers convicted of fraud may also lose their status as Medicaid providers.
The Texas Medicaid Fraud Control Unit
The Texas Medicaid Fraud Control Unit (MFCU) was created in 1979 as a division of the Office of the Attorney General. The Attorney General’s Medicaid Fraud Control Unit stands ready to investigate these allegations and bring perpetrators to justice.
The MFCU has four principal responsibilities:
- Investigating criminal and civil fraud by Medicaid providers
- Investigating physical abuse and criminal neglect of patients in health care facilities licensed by the TX Medicaid program, including nursing homes and Texas Department of Aging and Disability Services homes
- Investigating and prosecuting criminal fraud by Medicaid providers and/or assisting local and federal authorities with such prosecution
- Investigating fraud within the administration of the Medicaid program.
MFCU does not look into fraud committed by individual Medicaid recipients. The Texas Health and Human Services Commission Office of Inspector General is responsible for investigating Medicaid recipient fraud.